THE number of Gwent patients waiting more than 18 months for treatment began to rise again during April - and an early decision on cash for operations is vital to prevent further rises, NHS bosses warn.

Waiting times for 77 ear, nose and throat patients (up from 58 in March) and 33 general surgery patients (up from 0 to 31) breached the maximum 18-month target.

Demand in both specialties exceeds operating capacity in Gwent hospitals and although extra funding, allied to patients' willingness to go elsewhere for treatments, enabled targets to be met by March 31, funding arrangements are not finalised for 2004/05.

The Assembly has also not yet decided, says a Gwent Healthcare Trust report, how to divide £12m available through its Second Offer Scheme.

This gives patients who appear likely to have to wait more than 18 months for NHS treatment locally the option of private treatment paid for by the NHS, or NHS treatment in an English hospital.

The trust hopes extra funding to meet ENT and orthopaedic surgery waiting time targets will come through this scheme.

Referring to the increases in ENT and general surgery waiting times the report, by the trust's head of performance Allan Davies, states that "this represents the challenge of maintaining waiting time targets when demand exceeds supply and no funding mechanisms have yet been finalised.

"The trust hopes an early decision on funding is made, to finalise plans to prevent further deterioration with treatment breaches, and achieve targets as soon as possible."

Targets of no waiting for more than 18 months for orthopaedic operations and no more than four months for cataract surgery were maintained for Gwent patients during April.

But Mr Davies warned that around £6m more was required during £2004/05 to meet the treatment targets across all specialties.